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Sunday, April 5, 2009

"Sick Around America": A little bit sickening

Last week I watched “Sick Around America”[1], the PBS show Frontline. I was greatly looking forward to it as the follow-up to the outstanding show “Sick Around the World” that T.R. Reid, a former international correspondent for the Washington Post and Atlantic did last year. “Sick Around the World”[2] had Reid traveling to 5 countries to look at the way that they delivered health care. Carefully chosen to display a variety of approaches to providing health care to everyone, he visited three long-standing systems, the UK (National Health Service), Canada (single-payer), and Germany (a mixed public-private system), and two rather newer ones, Switzerland (early 90s) and Taiwan (early 2000s). In each country, he probed the people he interviewed, usually health ministers, sometimes prime ministers, and health scholars about the strengths and weaknesses of their programs, but in all he received the message that there was a sense of social responsibility and social justice. In each country he asked how many of their citizens went bankrupt as a result of health care debts, and they all said none. The most dramatic response was from the President of the Swiss Confederation, a conservative who had originally opposed the Swiss program in the early 90s. “No one,” he boomed in his French-accented English, “why, it would be a national scandal!”

The lesson from “Sick Around the World” was that there are many approaches to covering everyone, but that there must be an agreement and consensus to do so, a decision every (other) industrialized country has made. I paraphrase his ending: “For the US veteran in the VA system, healthcare is much like in the UK; for the retiree on Medicare it is like in Taiwan; for the employee with insurance, the US experience is much like in Germany; and, for the 40 million uninsured in the US, it is just another third-world country.” So I looked forward to see what Reid would show us in the US in “Sick Around America”.

The first thing that was apparent was the absence of T.R. Reid, which seemed very strange. The show was ok, I guess, following the trials of some people who had difficulty receiving health care (or not); kind of a watered-down version of parts of Michael Moore's Sicko! without the funny or the punch. There were some good points made, particularly around pre-existing conditions and medical underwriting; for example, when the chairman of one of the health insurance companies noted he had to keep his job because, since he had had cardiac surgery, he would not be able to get insurance on the individual market.

The difficulty and cost of getting insurance in that market was one of the big emphases of the program. The other, surprising, thing was how positively the health insurance companies, and their representatives such as Karen Ignagni of America’s Health Insurance Plans (AHIP), the trade group, are portrayed. The clear message was that our health insurance companies could cover everyone, without problems with exclusions for pre-existing conditions, if only everyone were required to be “in”. The message was that health insurance had to be mandated. The incredible cost of doing this while maintaining insurance company profits was never addressed. Nor was single-payer, the only reasonable alternative that would cover everyone and not cost a great deal more, precisely because it would eliminate the huge profits of the insurance companies.

Indeed, this was the message of “Sick Around the World”; in Switzerland, a country with a grand capitalist tradition and many insurance and drug companies, it turns out that the insurance companies, even before the new system was put in place, were not-for-profit. So how come Reid did not make sure this was pointed out? It turns out, amazingly, that the producers of Frontline dramatically changed the program to make the political point that they wanted to – this nonsense plan to require everyone to have health insurance which would be so amazingly costly that it would never work, and exclude any reference to single payer. And so Reid withdrew from the project. Excellent coverage of this by Russell Mokhiber of Counterpunch, including text of the exchange by the “moderator” and Ignagni[3]. Really disappointing of Frontline. Another effort of the “haves” to exclude a discussion of something that will meet the needs of all of us.